PERFORMING MNG A POST- IMPLEMENTATION SYSTEM

Transcription

1 1 PERFORMING MNG A POST- IMPLEMENTATION SYSTEM REVIEW JAN S. HERTZBERG MANAGING DIRECTOR GRANT THORNTON WILLIAM G. KISTNER VICE VC PRESIDENT &C CHIEF AUDIT EXECUTIVE NORTHWESTERN MEMORIAL HEALTHCARE AHIA 32 nd Annual Conference August 25-28, 2013 Chicago, Illinois

2 A POST-IMPLEMENTATION SYSTEM REVIEW LEARNING OBJECTIVES 2 Describe the benefits of performing a post- implementation review Discuss an approach to execute the review Identify potential issues that may arise during a post-implementation review Addressing post-implementation issues

3 Content 3 Background scope, p,g growth drivers, software delivery approaches, success factors, costs/benefits Options for Internal Audit's Involvement in Software Implementations Two Case Studies and Lessons Learned

4 Scope of Software Integration 4 Large-scale software integration can include many hospital departments and functions into a system that can serve all those departments particular needs. Software may include Enterprise Resource Planning (ERP), Electronic Medical Records (EMR) and other systems spanning: Core Services - Patient Registration, Emergency, In-Patient, Lab, OT Services, Blood Bank, Pharmacy, Electronic Medical Records Support Services Patient Billing, Appointment Scheduling, Diet & Kitchen, Linen & Laundry, Bio-Medical Waste, Transportation Back Office HRMS, Payroll Management, Accounts/Financial Management, Store/Inventory Management

5 Growth Drivers 5 Adopt Best Practices Improve Patient Care Reduce Operational Costs Achieve Regulatory Compliance

6 Software Delivery Approaches 6 Variations here include only portions of a business process that is hosted Less and less of the IT infrastructure and applications are "owned" by the customer Many companies use vendor facilities for backup and development Various vendor solutions between co- location and full managed services On Premise Dedicated data center and infrastructure Software and hardware located at customer location On-site support staff Co-location Hardware and software at off-site data center Data center may or may not be owned Customer ownership of hardware and software Identical IT and business processes as on premise Business users see no changes Security process is similar Hosted Referred to as managed services Offered by many software vendors and third parties Processes and controls setup by vendor Lower cost alternative to full outsourcing No internal IT staff Business support remains at customer Fully Outsourced Business processes and systems performed by external vendor All systems and business support personnel part of the vendor Fully responsible for support, maintenance, upgrades, etc. Standardized system and business processes Little or no flexibility Referred to as BPO Cloud Computing Shared infrastructure and services No ownership of software or hardware All processes are defined by vendor Support, security and program changes by the vendor Sometimes referred to as "on demand" or "utility computing" Large software vendors may offer solutions at every level and niche players fill in spots across the continuum

7 Success Factors 7 Defined business and IT strategic plans Approved software project business case Assigned project sponsors with cross functional team IT governance structure focused on ongoing project review and timely issues resolution and decision making Strong Project Management Office (PMO) Comprehensive change management, communications and training approach Well defined future state business processes

8 Software Implementation Costs 8 Financial costs Business performance will dip during implementation before being boosted by software People costs Training i -new skills and roles Turnover - change aversion vs. change acceptance Manage both software duties and day-to-day operations Process costs Need to instill a process discipline Technology costs Architectures need to be in place -a solid foundation for software Integration - software systems have strong conceptual links with every major information systems area

9 Software Implementation Costs and 9 Benefits rmance Perfor

10 Benefits 10 Software combines the needed functions of the applications that a hospital requires and integrates them into a single system Streamline processes and eliminate departmental silos Improve the efficiency and effectiveness of employees Gain control and visibility over the entire business Make better, more proactive decisions Data integration Reduces storage of redundant data Avoids re-keying and reformatting data from one system into another Reduces updating and debugging obsolete software code Improves communication links between systems to automate data transfer Software allows organizations to balance patient demands impacted by multiple interrelated items and multiple hospital locations Adapt to changing healthcare requirements more quickly

11 11 Options for Internal Audit's Involvement in Software Implementations Steering Committee Participation - provides advice on internal controls to the project sponsors and brings project management issue to their attention Full Project Team Participation i i -performs specific duties to ensure that individuals have performed the required tasks/prepared adequate documentation Periodic Review & Consultation - project team members contact Internal Audit during any phase of the project for advice on isolated operational or system controls

12 12 Options for Internal Audit's Involvement in Software Implementations. continued Implementation/Conversion Review reviews training schedule, user/application documentation, testing plan for adequacy, acceptance test results, implementation/conversion plan, backup/recovery plans, quality assurance methodology Post Implementation Review conduct an audit to determine if system is operating as intended, controls over input/output are adequate, users are trained, anticipated benefits have been realized, proper Systems Development Lifecycle (SDLC) methodology was followed

13 Post Implementation Review Approach 13 Scoping Questions Benefits Realization Have the intended objectives of the system been realized Have the actual costs and benefits been compared against budget Was the implementation process effective and appropriate What were the causes of time overruns, cost overruns, or quality or performance issues, if any What were the productivity and performance improvements resulting from the system Control Have business processes and internal controls been implemented Considerations Have user access controls been implemented in accordance with organizational policy Have users have been appropriately trained Is the system maintainable and can it be further developed effectively and efficiently Have available features and procedures, as relevant, been implemented Compliance Is the implementation compliant with relevant statutory requirements and organizational policies Is the implementation compliant with management's control objective framework and guidelines, as relevant What are the opportunities for further improvement in either the solution or implementation process

14 Northwestern Memorial HealthCare We are an academic medical center where the patient comes first first bed nationally recognized academic d i medical di l center t hospital 205-bed community hospital in Lake Forest, Forest IL 14 ambulatory sites in Chicago and suburbs Feinberg and Galter pavilions Prentice Women s Hospital Primary clinical affiliate of Northwestern University s Feinberg School of Medicine NMH #6 U.S. News & World Report Honor Roll and NLFH #19 in Chicago Northwestern Lake Forest Hospital

15 15 More than 10,000 People Come Together for Our Patients, t their Families and the Community 7,099 Employees 47,177 Inpatient Admissions $51.8M Charity Care 12,415 Deliveries 800+ Volunteers 2,537 Physicians $279.4M Community Benefit 83,805 ED Visits 750 Chicago Cares Volunteers 692 Quarter Century Club Members 591,238 Outpatient Registrations

16 Summary of NMHC Installations 16 NMH Registration/Scheduling Implementation of a pre-service interactive registration and scheduling ( Reg/Sched ) system. Implementation included: 32 departments with over 1,100 users Converted approximately 71,000 appointments Required training of 736 employees

17 Summary of NMHC Installations, continued 17 ERP Replacement of an existing system - included Human Resources, Supply Chain, and Financial Systems. As part of the implementation, the following were converted: 1,200 vendors 1,800 employees YTD payroll balances and benefits 7,900 procurement items 500 purchase orders 50 active capital projects 3,800 assets

18 Warning Signs 18 Viewed as an IT project Lack of strong executive sponsorship Lack of formal and disciplined project management Lack of proactive change management Lack of milestones or missed milestones Bd Budget overruns Lack of adequate training Lack of adequate testing (load and user acceptance) Too much customization Poor incident management and reporting

19 Key Issues Common Themes 19 Area of Key Finding Attribute Reg/Sched ERP Type of Project, perpmo Tracking System IT IT Steering Committee Members and Responsibilities PMO Scope Specified in Charter No Yes Advisory Committee Members and Responsibilities Specified in Charter No Yes Coordination SteeringCommittee involvedbusinessstakeholders stakeholders representing affected entities No Yes Key issues were reported in PMO tracking system No No Quality Management Issues were tracked by the project team outside the PMO tracking system Schedule Health status reported by PMO tool reflected slipped dates Yes No Yes N/A Procurement and Vendor Management Testing Detailed requirements prepared and compared to the solution's s capabilities during the Selection Process High level analysis performed as part of Selection Process Yes N/A Customer reference checks performed by business stakeholders No N/A User signoff prior to Integration Testing Yes No User signoff after Integration Testing No Yes Key functionality delivered late, i.e. less than month before go live Yes No No N/A

20 Key Roles and Responsibilities 20 Executive sponsor Leadership and commitment Business area Owner IT Support Supply chain Governance/oversight Outside consultants Support Internal Audit Oversight with an independent view

21 Internal Audit Role and Value 21 Proposition Have a seat at the table become an ally to business owners, IT, senior management and audit committee by providing an independent perspective p Pre-implementation and ongoing monitoring Proactive focus on accountability Post-implementation reviews Varies by project and organization

22 22 Questions & Thank You!

23 Save the Date September 21-24, rd Annual Conference Austin, Texas 23